Judge Neil Wake, who placed the jails under supervision years ago after determining that they neglected detainees, ruled that Sheriff Joe Arpaio's jails must remain under court supervision.

"Those in charge of Maricopa County's jails can no longer skirt their constitutional responsibility for detainees' health," commented Eric Balaban, staff attorney for the ACLU's National Prison Project. "Judge Wake found severe problems with the jails' medical care, from intake to treatment. Detainees have had serious illnesses that the jails' staff missed or ignored, causing permanent injuries and even deaths. With today's decision, every detainee at Maricopa County should have access to adequate medical and mental health care. At last."

Yesterday's ruling assessed the status of Wake's 2008 order, the third of several stemming from litigation first brought against the Maricopa County sheriff and Board of Supervisors by pretrial detainees in the late 1970s.

As things have improved (or failed to improve) in the county's jails, areas of supervision have shifted. Since 2008, Wake's Third Amended Judgement ordered Maricopa's jails to be watched over in several general areas: the screening of pretrial detainees upon their arrival to ensure that necessary segregation and treatment took place; the provision of access to care for pretrial detainees, including the option to transfer elsewhere if proper care were unavailable; the uninterrupted provision of medically necessary prescription medications; and the proper maintenance of records related to the order, including the delivery of quarterly reports on progress.

By January 2013, court documents show Arpaio and the Board of Supervisors were on the path toward compliance with the order, and doctors charged with assessing the jails released a list of specific recommendations to help them get all the way there. In a June status report, court records show, Arpaio and company listed the ways in which they were following those recommendations, but they also failed to address some of the recommendations and outright disagreed with others.

By August 2013, Arpaio and the Board of Supervisors asked the court to lift the 2008 order, arguing that the jails were in compliance with all of the court's requirements. An end to the order would have finalized the class action suit and with it the court's monitoring of Maricopa's jails.

And so began a lengthy assessment process, in which both sides presented written briefs, followed by a six-day evidentiary hearing in late February and early March of this year. At that hearing, the ACLU's local and national divisions offered evidence that the quality of the jails' medical and mental healthcare "caused unnecessary suffering," the ACLU said in a press release yesterday.

"We investigated, bringing medical and mental-health experts to the jail, and what we found showed Judge Wake that the jails have a long way to go before his order can be lifted," Balaban said.

Wake agreed. In his decision issued yesterday, he found the defendants--Arpaio and the Supervisors--had failed to prove that they'd met a long list of the court's specific requirements: that pretrial detainees with serious medical health needs at intake should be seen by medical providers in a timely fashion; that initial screenings should consistently identify and treat those at risk of serious alcohol or drug withdrawal; that those who presented as seriously mentally ill at intake should be seen by medical staff quickly, allowing for the continuation of necessary medications; that tuberculosis screenings should be conducted within 14 days of intake; that mentally ill detainees should be given sufficient assessment following removal from specialized mental-health units; that seriously mentally ill detainees in confinement more than 22 hours per day should have at least twice weekly visits with mental-health professionals; that mental-health providers should be consulted before the seriously mentally ill were placed in segregated confinement or before force was used against them; and more.

"The prospective relief ordered in the Third Amended Judgment remains necessary to ensure that pretrial detainees have ready access to adequate medical, dental, and mental health care; are not subjected to conditions that are likely to cause future serious illness and needless suffering; and are not deprived of timely medical, dental, or mental health care except where denial or delay of care is reasonably related to a legitimate governmental objective other than financial cost," Wake said.

Wake recognized that the provision of care in jails as busy as Maricopa's is difficult--nearly half of the 250 to 300 detainees processed daily need medical care, he wrote, and an average of 8,200 detainees and inmates are in the system on a given day--but he wasn't taking any excuses. "Having found constitutional violations, the Court may not allow constitutional violations to continue merely because remedies intrude into functions of prison administration, and Defendants' history of noncompliance with prior orders justifies greater court involvement than usually permitted," he said.

And so Wake issued the Fourth Amended Judgment, outlining exactly what needs to happen for Arpaio and company to escape the court's continued scrutiny. That order includes a timeline, which, if followed, will finalize the court's supervision within one year's time. The defendants will have 60 days to create or amend policies regarding each constitutional violation Wake found, 150 days to implement those policies, and then 180 days to collect data to assess (and prove) their own compliance.

The new judgment requires a more thorough intake screening of pretrial detainees, quicker turnaround times for detainees' requests for medical or mental-health treatment, closer supervision of detainees going through withdrawal or recently taken off suicide watch, consultation with mental-health providers before force is used or segregation is ordered for mentally ill detainees, adoption of new policies regarding disciplinary procedures and the use of isolation with the mentally ill, more timely administration of prescription medications, and documentation of the reasons when required face-to-face assessments don't occur, among other things.

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After all the necessary policy changes have been made, implemented, and analyzed, the order says, the defendants must turn a report in to the court assessing the results. That report--which will be used to determine whether Arpaio and the Supervisors are finally in compliance--is due next September 15.

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